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Respiratory Medicine > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A
  • A chronic inflammatory airway disease characterised by intermittent airway obstruction and hyperreactivity.
  • It is a disease of small airways with variable expiratory airflow limitation
  • Inflammation is reversible spontaneously or with treatment
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2
Q

What are some precipitating factors that can trigger asthma? Name two drugs.

A
  • NSAID’s, beta blockers

- Allergens, dust, smoking, cold weather, exercise, infection, aerosols

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3
Q

What 3 factors contribute to airway narrowing in asthma?

A
  1. Bronchial muscle contraction
  2. Mucosal inflammation and swelling - triggered by mast cell and basophil degranulation resulting in release of inflammatory mediators
  3. Increased mucus production
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4
Q

What are some symptoms of asthma?

A

Intermittent dyspnoea, wheeze, dry cough (nocturnal),

scanty white sputum production, SOB, chest tightness , atopy

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5
Q

What are some signs of asthma?

A

Tachypnoea, audible widespread polyphonic wheeze, hyperinflated chest, hyper-resonant percussion, reduced air entry,

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6
Q

What are the two features of a mild asthma exacerbation?

A
  1. No features of severe asthma

2. PEFR >75%

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7
Q

What are two features of a moderate asthma exacerbation?

A
  1. No features of severe asthma

2. PEFR 50-75%

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8
Q

What are the four features of acute severe asthma exacerbation? Note you only need one to make the diagnosis…

A
  1. PEFR 33-50% of best or predicted
  2. Cannot complete sentences in one breath
  3. Respiratory rate >25/min
  4. Heart rate >110/min
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9
Q

What are the four features of life threatening asthma? Note you only need one to make the diagnosis…

A
  1. PEFR <33% of best or predicted
  2. Sats <92% or ABG pO2<8kPa
  3. Cyanosis, poor respiratory effort, near or fully silent chest
  4. Exhaustion. confusion, hypotension of arrhythmias
    (Normal pCO2)
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10
Q

What distinguishes a life threatening asthma exacerbation to near fatal?

A

Near fatal asthma exacerbation, the patient will have a raised pCO2

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11
Q

A patient has come into hospital with an acute exacerbation of asthma, what investigations would you do (4)?

A

Bloods - FBC, U+E, CRP, cultures
PEF - But may be too ill
aBG - If shows life threatening features/O2 sats <92%
CXR - If suspicion of pneumothorax, infection or life threatening attack

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12
Q

What is the immediate management of an acute exacerbation of asthma?

A
  1. ABCDE assessment
  2. Supplemental O2 to keep O2 sats 94-98%
  3. Salbutamol 5mg nebulised with O2
  4. Hydrocortisone 100mg IV (if PO not possible), or 40mg prednisolone STAT
  5. If severe, nebulised 500micrograms/6hr iprotropium bromide
    Consider back to back salbutamol
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13
Q

What should you do when reassessing a patient after 15 mins in acute exacerbation of asthma?

A
  1. If PEF<75%, repeat salbutamol nebulisers every 15 minutes or 10mg/hr continuously
  2. Monitor ECG and watch for arrythmias
  3. Consider single dose of magnesium sulfate 1.2-2g IV over 20 minutes in severe/life threatening without good initial response to therapy
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14
Q

What should you do with a patient with acute exacerbation of asthma when they are not improving after 15 minutes?

A
  1. Refer to ICU for ventilation

2. Consider aminophylline and IV salbutamol

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15
Q

What should you do with a patient with acute exacerbation of asthma when they are improving after 15 minutes?

A
  1. Continue nebulised salbutamol every 4-6hrs and ipratropium if previously started
  2. Prednisolone 40-50mg PO OD for 5-7 days
  3. Monitor peak flow and O2 sats, aim for 94-98%
  4. If PEF>75% 1hr after initial treatment, consider discharge with outpatient follow up
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16
Q

When can you discharge a patient after acute exacerbation of asthma?

A
  • If their PEF>75% within 1hr of treatment
    OR IF AFTER ADMISSION…
  • Been stable on discharge medication for 24hrs
  • Had inhaler technique checked
  • PEF > 75% predicted and variability <25%
  • Steroid (inhaled and oral) and bronchodilator therapy
  • Have their own PEF meter and have a written management plan
  • GP appointment within 2 days
  • Respiratory clinic appointment within 4wks
17
Q

A patient comes in and you think they have asthma - what investigations would you do initially?

A

Spirometry, and if not available do PEF.

18
Q

A patient has had their spirometry and it shows a high probability of asthma - what do you do?

A

Trial asthma treatment.

If successful, continue at minimum effective dose. If unsuccessful, assess inhaler technique/compliance.

19
Q

A patient has had their spirometry and it shows a medium probability of asthma - what do you do?

A

If their FEV1/FVC <0.7, try asthma treatment.

If their FEV1/FVC >0.7, consider referral/treat other cause.

20
Q

What will spirometry show if a patient has asthma?

A

An obstructive pattern. FEV1/FVC<70%. There will be a >15% improvement in FEV1 once given a B2 agonist/steroid trial.

21
Q

What will a CXR show if a patient has asthma?

A

Hyperinflation

22
Q

What are some differential diagnoses to asthma?

A 
Pulmonary oedema - 'cardiac asthma'
COPD
Large airway obstruction 
SVC obstruction - wheeze is constant 
Pneumothorax 
PE
Bronchiectasis
Obliterative bronchiolitis
23
Q

What are some associated diseases with asthma?

A

Acid reflux
Polyarteritis nodosa
Churg-Strauss syndrome
ABPA

24
Q

What are some lifestyle changes you can tell a patient with asthma to make?

A

Quit smoking
Avoid triggers
Weight loss if overweight
Inhaler technique - Peak flow meter to monitor PEF twice a day
Educate to enable self management by altering medication as needed
Give written action plans for an emergency
Teach relaxed breathing to avoid dysfunctional breathing

Respiratory Medicine (14 decks)

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